ST segment depression: Difference between revisions
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== | ==Evaluation== | ||
*Contour: | *Contour: Most→Least concerning for ischemia: Planar/Flat (90%) → Concave up (33%) → Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern) | ||
*Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise | *Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise | ||
*Indicators of ischemia: | *Indicators of ischemia: | ||
** | **>0.5mm depression from baseline (especially >1mm) in two or more contiguous leads | ||
**Transient depression | **Transient depression | ||
**Morphology that is flat or downsloping | **Morphology that is flat or downsloping | ||
| Line 13: | Line 13: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Posterior MI (including posterior [[STEMI]]) | *[[Posterior MI]] (including posterior [[STEMI]]) | ||
*RV strain | *RV strain | ||
*[[NSTEMI]] | *[[NSTEMI]] | ||
*Reciprocal changes | *Reciprocal changes | ||
*[[Electrolyte Disorders]] (e.g. [[hypokalemia]]) | *[[Electrolyte Disorders]] (e.g. [[hypokalemia]]) | ||
*[[SVT]] | |||
*[[RBBB]]/[[LBBB]] | |||
*[[LVH]] with strain pattern (repolarization abnormality) | *[[LVH]] with strain pattern (repolarization abnormality) | ||
*Digoxin effect (not indicative of toxicity) | *[[Digoxin]] effect (not indicative of toxicity) | ||
*[[Ventricular paced]] pattern | |||
==See Also== | ==See Also== | ||
*[[ECG (Main)]] | *[[ECG (Main)]] | ||
== | ==References== | ||
<references/> | |||
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA | ST Elevation Lecture, Dr. Niemann, Harbor-UCLA | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 11:05, 25 November 2021
Evaluation
- Contour: Most→Least concerning for ischemia: Planar/Flat (90%) → Concave up (33%) → Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern)
- Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise
- Indicators of ischemia:
- >0.5mm depression from baseline (especially >1mm) in two or more contiguous leads
- Transient depression
- Morphology that is flat or downsloping
- Strain:
- tall R wave
- only in lateral leads (not anterior)
- "checkbox" or asymmetric TWI
- down sloping pattern
Differential Diagnosis
- Posterior MI (including posterior STEMI)
- RV strain
- NSTEMI
- Reciprocal changes
- Electrolyte Disorders (e.g. hypokalemia)
- SVT
- RBBB/LBBB
- LVH with strain pattern (repolarization abnormality)
- Digoxin effect (not indicative of toxicity)
- Ventricular paced pattern
See Also
References
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA